Food preferences and aversions of patients undergoing chemotherapy, radiotherapy and/or hematopoietic stem cell transplantation

Nonrestrictive diet does not increase infections during post-HSCT neutropenia: data from a multicenter randomized trial

Infections are a major cause of morbidity and mortality during neutropenia after hematopoietic stem cell transplantation (HSCT). The use of a low-microbial protective diet (PD) in the peritransplantation period is a standard of care, although its efficacy has never been tested prospectively. We conducted a multicenter, randomized, noninferiority trial, enrolling all consecutive adult patients undergoing high-dose induction chemotherapy or HSCT with the objective to compare nonrestrictive diet (NRD) vs PD. Overall, 222 patients were enrolled, randomly assigned, and analyzed. One hundred seventy-five subjects (79%) received autologous HSCT (auto-HSCT), 41 (18%) received allogeneic HSCT (allo-HSCT), and 6 (3%) patients received high-dose induction chemotherapy. There was no significant difference in terms of incidence of grade ≥2 infections and death during neutropenia in the 2 arms. In multivariable analysis, only multiple myeloma diagnosis, fluoroquinolone prophylaxis, and the absence of mucositis were associated with a lower incidence of grade ≥2 infections. We did not report any significant variation in terms of hospitalization length, incidence of mucositis and gastrointestinal infections, body weight, and serum albumin variations in the 2 arms. In allo-HSCT recipients, the incidence of acute graft-versus-host disease grade ≥3 was similar. NRD was associated with higher patient-reported satisfaction. In conclusion, NRD is not inferior to a traditional PD during neutropenia after HSCT, and our results demonstrated that implementing a restrictive diet unnecessary burdens patients' quality of life. The clinical trial was registered prospectively in the clinical trial registry of the Istituto Nazionale dei Tumori of Milan as INT54/16.

Food Aversion during Cancer Treatment: A Systematic Review

Individuals with cancer often present food aversion after initiation of anti-tumor treatment, which may impair nutritional status. We aim to assess the prevalence and factors associated with food aversion during cancer treatment. Articles from three databases were searched: MEDLINE, EMBASE and Cochrane Library. English was used, with no restriction on the year of publication. Inclusion criteria were original articles that evaluated food aversion in adults and the elderly undergoing chemotherapy and/or radiotherapy treatment. Fifteen articles were included. A high prevalence of food aversion (21-62%) was observed, with meat considered the most aversive food. The aversion is usually transient and may be due to gastrointestinal problems, such as nausea and vomiting, caused by chemotherapy or radiotherapy treatment, and even psychological and emotional issues. Offering a new food before the beginning of treatment seems to be an effective strategy to reduce aversion, combined with nutritional and psychological monitoring. Cancer patients have a high prevalence of food aversion. Multidisciplinary care can minimize the consequences of cancer treatment.